Paediatric service drop during early COVID-19 hints at future pandemic preparedness

Clinical attendance for ambulatory paediatric care has decreased during the early COVID-19 period in a large tertiary teaching hospital in Singapore, reports a study, noting implications for future pandemic preparedness including healthcare resource allocation and communication.

“Although ambulatory paediatric services remained generally available during the early COVID-19 period in Singapore, the volume of visits was significantly lower than baseline, and the default rates for both first visits and follow-up visits increased significantly,” the researchers said. “This suggests families were not seeking ambulatory paediatric care although it was available.”

In this study, independent t-tests were utilized to compare the weekly aggregate clinic attendance and default rates of different time periods of the early COVID-19 pandemic (ie, early period, movement controls, release of movement controls).

A significant decrease in total weekly attendance and a substantial increase in default rates were noted during the early COVID-19 period prior to the implementation of movement controls. [Proc Singap Healthc 2024;doi:10.1177/20101058241270882]

Movement restriction

The first visit default rate during the movement control period remained significantly increased despite the postponement of all nonessential first visits. During the release of movement restrictions, both the first and follow-up visits returned to pre-COVID-19 levels. In the postmovement control period, the default rate for follow-up visits was markedly reduced compared with baseline levels.

“During the early COVID-19 period, our total number of visits decreased by 39.6 percent, and during the COVID-19 movement controls, our total number of visits decreased by 60.8 percent,” the researchers said.

Such trend mirrored that in paediatric outpatient visits reported from studies in other countries such as Spain (40 percent to 50 percent), South Korea (37.5 percent), Germany (35 percent), and Japan (45 percent). [JMIR Pediatr Parent 2024;7:e49943; Lancet Diabetes Endocrinol 2021;9:413-415; BMC Res Notes 2021;14:140; Int J Environ Res Publ Health 2023;20:7133]

“Thus, during a pandemic, decreased clinical volume in ambulatory paediatric clinics is likely and thus healthcare workers and clinical space can be redirected to meet the needs of pandemic-related medical care, as required,” according to the researchers. [Yonsei Med J 2019;60:796-803; MMWR Morb Mortal Wkly Rep 2020;69:630-631]

“The magnitude of these decreases in clinic volume also highlights the role of telemedicine as an important tool in a pandemic setting to ensure timely paediatric care,” they added. [J Prim Care Community Health 2020;11:2150132720969557; JMIR Pediatr Parent 2024;7:e49943; Medicine (Baltimore) 2022;101:e28884; JMIR Pediatr Parent 2023;6:e41554]

Rebound effect

Other countries also noted a rebound in non-COVID-19 ambulatory healthcare utilization as COVID-19 conditions improved and movement restrictions were lifted. However, studies reported a slower rate and a smaller magnitude of this rebound effect, and many countries did not show a full return to their prepandemic baseline. [BMC Res Notes 2021;14:140; Int J Environ Res Publ Health 2023;20:7133; Medicine (Baltimore) 2022;101:e28884 Publ Health 2024;226:99-106; Nat Med 2022;28:1314-1324]

"This likely reflects differences in the country-specific COVID-19 situation at the time, health system resilience including service availability, as well as patient and family preferences,” the researchers said. “Health systems also must plan to meet these postpandemic needs.” [J Pediatr (Rio J) 2021;97:369-377]